Category: Parkinson's Disease: Non-Motor Symptoms
Objective: Exploring predictive clinical factors of subthalamic stimulation (STN-DBS) which affect impulsive and compulsive behavior (ICB).
Background: ICB is frequently observed in Parkinson’s Disease (PD) whereas the effects of STN-DBS on these symptoms are not sufficiently investigated yet.
Method: We performed a prospective, open-label, multicenter study examining PD patients preoperatively and 6 months postoperatively. Effects on ICB were analyzed using the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), Unified PD Rating Scale additionally to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analyzed with the Wilcoxon signed-rank test and Bonferroni correction. To reveal predictors of QUIP-RS changes, we used correlations and linear regressions. In the end we divided our patients in “QUIP-RS improvement or worsening” to analyze differences between the two groups.
Results: A total of 55 patients at the age of 61.7 years ±8.4 with a PD duration of 9.8 years ±4.6 were included. Via QUIP-RS cut-offs and psychiatric assessments, we were able to single out patients with preoperative ICB. In patients with ICB, a significant improvement in QUIP-RS could be observed. While 29.1% of patients improved, there were also 27.3% who worsened which shows the interindividual variability of STN-DBS on clinically relevant QUIP-RS outcomes. Post-hoc analyses identified higher baseline QUIP-RS and lower baseline LEDD-DA as clinical factors which have a great impact on QUIP-RS improvements. Furthermore, severe baseline deficits in the NMSS attention/memory domain were frequently observed in “QUIP-RS worsening” group.
Conclusion: These findings indicate that beneficial effects of STN-DBS on ICB is associated with a higher preoperative ICB severity and lower doses of dopamine agonists preoperatively. Less favorable outcomes regarding ICB were related to more severe baseline deficits in the NMSS attention/memory domain. Our results underline the great importance of detailed preoperative assessment of non-motor and motor symptoms in PD patients undergoing STN-DBS.
To cite this abstract in AMA style:A. Sauerbier, P. Loehrer, S. Jost, S. Heil, J. Petry-Schmelzer, J. Herberg, P. Bachon, S. Aloui, A. Gronostay, L. Klingelhoefer, J. Baldermann, D. Huys, C. Nimsky, M. Barbe, G. Fink, P. Martinez-Martin, K. Chaudhuri, V. Visser-Vandewalle, L. Timmermann, D. Weintraub, H. Dafsari. Clinical predictors of impulsive and compulsive behavior after subthalamic stimulation in Parkinson’s disease [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/clinical-predictors-of-impulsive-and-compulsive-behavior-after-subthalamic-stimulation-in-parkinsons-disease/. Accessed December 1, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-predictors-of-impulsive-and-compulsive-behavior-after-subthalamic-stimulation-in-parkinsons-disease/